PDF
ePub
Citation
Print
Abstract
Purpose
Factors related to nonurologic postoperative complications of laparoscopic surgery in the urologic area were examined. The most significant factors were isolated and analyzed to establish ways to reduce the complication rate.
Materials and Methods
The medical records of 154 patients who had undergone laparoscopic surgery between March 2004 and March 2008 were reviewed. Age, anesthetic time, American Society of Anesthesiologists physical status classification, operative difficulty, blood loss (ml), body mass index (BMI), and complications were assessed. Complications were divided into 5 groups based on the modified Clavien classification. Grade 0 to 1 was defined as a no complication group and grades 2 to 5 as a complication group. The Armitage trend test was performed to study the relations between the factors and the complications. Univariate and multivariate analyses were performed to determine the risk ratio of each of the factors and the most significant factors.
Results
Complications tended to increase as the anesthetic risk and anesthetic time increased (p=0.011, 0.013, respectively). Operative difficulty and blood loss were related to complications (p=0.018, p<0.001, respectively). The univariate analysis revealed that blood loss of more than 400 ml compared with less than 200 ml had a risk ratio of 18.2. Moderate and hard operative difficulties had a significant risk ratio of around 4, and high anesthetic risk had a high risk rate of around 5. The multivariate analysis showed that blood loss and high anesthetic risk were independent risk factors of complications.
REFERENCES
1. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991; 146:278–82.
2. Kim TH, Cho WY, Kwak JJ, Yoon JH, Sung GT. Comparison of laparoscopic radical nephrectomy with open radical nephrectomy. Korean J Urol. 2007; 48:259–64.
3. Mangano DT. Perioperative medicine: NHLBI working group deliberations and recommendations. J Cardiothorac Vasc Anesth. 2004; 18:1–6.
4. Colombo JR Jr, Haber GP, Jelovsek JE, Nguyen M, Fergany A, Desai MM, et al. Complications of laparoscopic surgery for urological cancer: a single institution analysis. J Urol. 2007; 178:786–91.
5. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996; 77:217–22.
6. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–83.
7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–13.
8. Guillonneau B, Abbou CC, Doublet JD, Gaston R, Janetschek G, Mandressi A, et al. Proposal for a “European Scoring System for Laparoscopic Operations in Urology”. Eur Urol. 2001; 40:2–6.
9. Matin SF. Laparoscopic approaches to urologic malignancies. Curr Treat Options Oncol. 2003; 4:373–83.
10. Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol. 2007; 177:580–5.
11. Lim DH, Rho J, Kim CS. Complications of retroperitoneal laparoscopic surgery. Korean J Urol. 2006; 47:1294–301.
12. Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941; 2:281–4.
13. Cohen MM, Duncan PG, Tate RB. Does anesthesia contribute to operative mortality? JAMA. 1988; 260:2859–63.
14. Tiret L, Hatton F, Desmonts JM, Vourc'h G. Prediction of outcome of anaesthesia in patients over 40 years: a multifactorial risk index. Stat Med. 1988; 7:947–54.
15. Han KR, Kim HL, Pantuck AJ, Dorey FJ, Figlin RA, Belldegrun AS. Use of American Society of Anesthesiologists physical status classification to assess perioperative risk in patients undergoing radical nephrectomy for renal cell carcinoma. Urology. 2004; 63:841–6.
16. Matin SF, Abreu S, Ramani A, Steinberg AP, Desai M, Strzempkowski B, et al. Evaluation of age and comorbidity as risk factors after laparoscopic urological surgery. J Urol. 2003; 170:1115–20.
17. Lai FC, Kau EL, Ng CS, Fuchs GJ. Laparoscopic nephrectomy outcomes of elderly patients in the 21st century. J Endourol. 2007; 21:1309–13.
18. Routh JC, Bacon DR, Leibovich BC, Zincke H, Blute ML, Frank I. How long is too long? The effect of the duration of anaesthesia on the incidence of non-urological complications after surgery. BJU Int. 2008; 102:301–4.
Table 1.
Characteristics of the patients and surgical outcome
| Characteristics | |
|---|---|
| No. of patients | 154 |
| Male | 90 (58.4%) |
| Female | 64 (41.6%) |
| Age (years) | 55.2±13.9 (18-80) |
| BMI | 24.3±3.5 (15.67-33.98) |
| Surgical results | |
|---|---|
| Mean anesthetic time (min) | 384.6±149.0 (145.0-940.0) |
| Estimated blood loss (ml) | 260.9±245.8 (10.0-1,200.0) |
Table 2.
Classification of operative difficulty
Table 3.
Complications after laparoscopic surgery
Table 4.
The relationship between postoperative complications and each factor (by Armitage trend test)
ASA: American Society of Anesthesiologists, ESS: European Scoring System, EBL: estimated blood loss, BMI: body mass index. Complication tends to increase as anesthetic risk (ASA)anesthetic time, operative difficulty and estimated blood loss (EBL) increase. However, BMI and age had no relation with complication
Table 5.
Odds ratio of postoperative complications of each factor (by multivariate analysis)
OR: odd ratio, CI: confidence interval, EBL: estimated blood loss, ESS: European Scoring System, ASA: American Society of Anesthesiologists, BMI: body mass index. EBL more than 200 ml and high anesthetic risk (ASA 3) proved to be independent factors of postoperative complication. However, age, operative difficulty, anesthetic time and BMI did not show significant risk of complication
XML Download